This study is designed to investigate the viral etiology of chronic otitis media with effusion (OME) using a novel application of a very sensitive DNA amplification technique called the polymerase chain reaction (PCR). Chronic OME in children results in mild to moderate hearing loss which can lead to deficits in language and learning skills and, if unresolved, can result in more serious middle ear disease such as cholesteatoma. The role of viruses in the etiology of OME, both acute and chronic, has received greater attention as virus detection techniques improve and the reported frequency of viruses in OME cases increases. The role of viruses in chronic OME may be particularly important, because most cases do not resolve with antibiotic therapy. In this proposal the middle ear effusions of patients undergoing surgery for the placement of ventilation tubes will be analyzed for the presence of DNA and RNA of viruses thought to play a role in the disease. the use of PCR in analyzing middle ear effusions represents a novel application of a technique that has revolutionized the practice of molecular biology since its introduction in 1985 (Science 252:1643-1651, 1991). Recent workshops on otitis media have identified the need for investigations of the viral etiology of otitis media using better virus detection techniques [9, 31]. The possibility of a combined viral and bacterial etiology for chronic OME will be evaluated by performing bacterial cultures and gram stains on the same patient samples investigated using PCR. The long term goals of this project are to understand the role of viruses in OME and investigate the utility of antiviral therapy in resolving the disease.